Polyclonal Fluorescence Polarization Immunoassay Research Articles

Correlations between Calcineurin Phosphatase Inhibition and Cyclosporine Metabolites Concentrations in Kidney Transplant Recipients: Implications for Immunoassays

Cyclosporine exhibits a wide spectrum of metabolites that vary considerably in the extent to which they interfere with the various parent drug monitoring immunoassays. There is no consensus regarding the clinical significance of metabolites. Cyclosporine exerts its immunosuppressive action by inhibiting the enzyme calcineurin phosphatase. Determination of the enzyme's activity is one of the most promising pharmacodynamic markers. It is unknown how calcineurin phosphatase inhibition correlates with various cyclosporine monitoring assays and what is the potential impact of metabolites in this perspective? The aim of the present study was to determine the concentration of cyclosporine (by means of three different assay methods) and the four most significant metabolites (AM1, AM4N, AM9, and AM1C) in relation to calcineurin phosphatase inhibition. Twelve randomly selected cyclosporine-treated renal transplant patients were included in the study. Blood samples were drawn before, 1, 2, 3, 4, 6, 8, and 12 hr after oral intake of cyclosporine. Parent drug and metabolites were determined by liquid chromatography/tandem mass spectrometry (LC/MSMS). Additionally, cyclosporine concentration was determined by the enzyme multiplied immunoassay technique (EMIT) and by the polyclonal fluorescence polarization immunoassay (pFPIA). Calcineurin phosphatase activity was measured by its ability to dephosphorylate a previously phosphorylated 19-amino acid peptide. We found that calcineurin phosphatase inhibition correlates strongly with parent cyclosporine metabolites concentrations determined by all three assay methods. Determination methods that took metabolites into consideration exhibit stronger correlations with calcineurin phosphatase inhibition (sum of cyclosporin plus metabolites r=-0.93, LC/MSMS; pFPIA r=-0.94, P<or=0.001), compared with methods that measure exclusively the parent drug (EMIT: -0.84; LC/MS-MS: -0.81, P<or=0.05). Our results indicate that the immunosuppressive role of cyclosporines metabolites should not be considered valueless per se. Further research is required in order to verify the potential clinical importance of our observations.

Comparison of predose vs 2-h postdose blood metabolites/cyclosporine ratios in kidney and liver transplant patients

Objectives: It has recently been suggested that when adjusting doses of cyclosporine (CsA), determining its concentration in blood samples taken 2 h postdose (C 2) is more clinically beneficial than using the predose concentration (C 0). We determined C 0 and C 2 concentrations of CsA and their metabolites in samples taken from nine kidney and seven liver transplant patients. Similarly, the so-called metabolic ratios (MR)—metabolites to CsA parent ratios—were calculated to characterise the most suitable moment of blood sampling for obtaining a greater analytical specificity with monoclonal immunoassays. Methods: The determination of CsA and CsA + metabolites was made using the enzyme multiplied immunotechnique and the polyclonal fluorescence polarization immunoassay Abbott TDx, respectively. Results: The poor correlation between C 0 and C 2 of CsA ( n = 82, r = 0.387, p < 0.001) is greatly inferior to that obtained between C 0 and C 2 of metabolites ( n = 82, r = 0.912, p < 0.001). A highly significant difference ( p < 0.001) was found between MR 0 values (mean 2.87 ± 0.12, median 2.48) and MR 2 values (mean 1.73 ± 0.09, median 1.46), although there is a good correlation between them ( r = 0.878, p < 0.001). Conclusions: The extent of the positive bias (deviation) of CsA immunoassays compared with the high-performance liquid chromatography results is related to the MR values. As the MR 2 values are significantly lower than the corresponding MR 0, in practice a greater analytical specificity would be obtained with the different monoclonal immunoassays in the determination of the 2 h postdose CsA concentration than in that of trough concentration.

Whole blood cyclosporin monitoring in liver and heart transplant patients: evaluation of the specificity of a fluorescence polarization immunoassay and an enzyme-multiplied immunoassay technique

The specificity of two cyclosporin immunoassays were evaluated. Eleven patients were followed for the first four weeks after heart ( n = 3) or liver ( n = 8) transplantation. Cyclosporin A (CsA) monitoring was performed concomitantly by a monoclonal fluorescence polarization immunoassay (mFPIA) and enzyme-multiplied immunoassay technique (EMIT ®) during this period. For several patients, cyclosporin monitoring was also performed by high performance liquid chromatography (HPLC) or by polyclonal fluorescence polarization immunoassay (pFPIA). Liver function was assessed by follow-up of plasma total bilirubin, γ-glutamyl transferase and alkaline phosphatase and renal function by plasma creatinine. All the patients presented episodes of impaired liver function. Higher CsA levels were found using mFPIA measurements as compared to the EMIT ® measurements (ratio mFPIA:EMIT ® (medium range) = 1.4 (1.0–2.3)). A higher degree of cross-reactivity of the antibody used in the mFPIA as compared to the EMIT ® was demonstrated by specific measurements of CsA and its primary metabolite, AMl, by HPLC.

Progress Report of an External Quality Assessment Scheme for Cyclosporine Assay

Beginning in 1987, an external quality assessment (EQA) scheme for cyclosporine (CsA) assay was organized by our Institute and supported by National Research Council (CNR); in 1991, the CNR EQA joined the French CsA interlaboratory program organized by Service de Radiopharmacie et Radioanalyse, University of Lyon. During the last 2 years (1993 and 1994 cycles), > 170 laboratories (from seven European countries) participated in this survey, assaying 44 control samples prepared from pooled blood of heart- and renal-transplant patients; normal pools added with known amounts of CsA were also distributed. During the whole EQA period, a trend toward the use of specific and nonisotopic techniques has been observed. In 1994, 91% of the collected results have been produced by specific methods [high-pressure liquid chromatography (HPLC) or specific immunoassays developed to assay the native molecule of CsA without its metabolites];in the same cycle, the fully automated techniques [TDx, fluorescence polarization immunoassay (FPIA), and enzyme-multiplied immunoassay (EMIT)] accounted for 73% of total results. CsA concentration measured by monoclonal specific immunoassays [(TDx FPIA, radioimmunoassay (RIA) Cyclo-Trac, and EMIT] was well correlated with those from HPLC (r = 0.99-1.00); results from EMIT were very close to those from HPLC, whereas results from RIA Cyclo-Trac and TDx were slightly overestimated (10-20%). Nonspecific methods (TDx polyclonal and nonspecific RIA Cyclo-Trac) measured CsA concentrations 3-4 times higher than those found by HPLC. The cross-reactivity of CsA metabolites in specific immunoassays was estimated from data of patients' samples and spiked samples; an interference of 6% in RIA Cyclo-Trac, 7% in EMIT, and 26% in TDx FPIA was found. The precision coefficient of variation (CV% between laboratory and between assay) of the methods observed in the 1994 EQA cycle was 9.5 for TDx polyclonal FPIA, 10.4 for TDx monoclonal FPIA, 10.5 for EMIT, 10.6 for RIA specific Cyclo-Trac, 14.2 for RIA nonspecific Cyclo-Trac, and 15.2 for HPLC.

Evaluation of The Pharmacokinetic Interaction Between Cemetidine or Famotidine and Cyclosporine in Healthy Men

To investigate the potential interaction between cimetidine or famotidine and cyclosporine in healthy men. All subjects received oral cyclosporine at baseline, after the first week of 1 histamine2 (H2)-blocker, and a third time after a 1-week washout plus 1 week of the second H2-blocker. Blood samples were collected just before each dose of cyclosporine and for up to 36 hours afterward for pharmacokinetic analysis. A college of pharmacy in a university teaching hospital. The study population consisted of 8 healthy men at least 19 years of age. Cyclosporine concentrations in whole blood were measured using a polyclonal fluorescence polarization immunoassay. Cyclosporine pharmacokinetic parameters during each of the 3 treatment periods were compared. The average times to maximum cyclosporine concentrations were similar between baseline (3.2 h), cimetidine (2.9 h), and famotidine (3.6 h) dosing periods. There were no significant differences in area under the curve, half-life, or maximum concentration during the 3 dosing periods. Neither cimetidine or famotidine produced a significant change in the pharmacokinetics of single-dose oral cyclosporine in healthy men.

Simultaneous quantification of cyclosporin A and its major metabolites by time‐of‐flight secondary‐ion mass spectrometry and matrix‐assisted laser desorption/ionization mass spectrometry utilizing data analysis techniques: Comparison with high‐performance liquid chromatography

Simultaneous quantification of cyclosporin A (CsA) and its major metabolite (AM1) in blood has been achieved using time‐of‐flight secondary‐ion mass spectrometry (TOF‐SIMS) and matrix‐assisted laser desorption/ionization time‐of‐flight mass spectrometry (MALDI/TOF‐MS). Previous investigations indicated that spectral interferences exist in the analysis of CsA blood samples by the above methods. In TOF‐SIMS, interference is caused by overlap of the Ag‐cationized internal standard, cyclosporin D (CsD), with the Ag‐cationized metabolite, AM1. To resolve this interference and obtain quantitative information, cross‐correlation analysis was applied to the TOF‐SIMS data. Application of damped non‐linear least squares curve‐fitting was carried out to resolve an interference in the MALDI/TOF‐MS data due to multiple cationization products (i.e. Na and K). Measurement of standard samples indicates that the minimum accuracy (95% confidence level) of the TOF‐SIMS method was better than 9% for CsA and 13% for AM1 using only one standard curve'. Similarly, the minimum accuracy of the MALDI/TOF‐MS method was determined to be 14% for CsA and better than 25% for AM1. Blood samples obtained from transplant patients receiving CsA were analyzed by polyclonal fluorescence polarization immunoassay, high‐performance liquid chromatography (HPLC), and by both TOF‐MS methods. Both TOF‐MS results for CsA and mono‐hydroxylated CsA are in good agreement with the HPLC results.

PHARMACODYNAMIC STUDIES OF CYCLOSPORINE IN MARROW TRANSPLANT RECIPIENTS

We investigated the correlation between trough cyclosporine concentration in plasma measured by polyclonal fluorescence polarization immunoassay (FPIA) and polyclonal radioimmunoassay (RIA) or in whole blood measured by high-performance liquid chromatography (HPLC) and the risk of renal dysfunction or acute graft-versus-host disease in 29 patients undergoing allogeneic bone marrow transplantation for leukemia. The FPIA and RIA values were highly correlated (r = 0.93) and on the average CsA concentrations measured by FPIA were 1.56 times higher than those measured by RIA. Ten patients developed renal dysfunction and 10 developed grades II-IV acute GVHD. Although univariate analysis showed that plasma CsA concentrations measured by either FPIA or RIA were significantly correlated with renal dysfunction, the association was stronger with FPIA. Plasma CsA concentrations measured by FPIA but not RIA remained a significant risk factor for renal dysfunction in a multivariate relative risk model. Amphotericin therapy was significantly associated with renal dysfunction in the univariate analysis but not in the multivariate analysis. No significant associations were found between whole blood CsA or CsA M1 concentration, patients' age, gender, or CsA dose and the risk of renal dysfunction. None of the covariates analyzed significantly correlated with the development of acute GVHD. These data suggest that plasma CsA concentrations measured by nonspecific assays may more accurately correlate with renal dysfunction than whole-blood CsA concentrations measured by HPLC in marrow transplant recipients.

Comparison of a Monoclonal Antibody Fluorescent Polarization Immunoassay with Monoclonal Antibody Radioimmunoassay for Cyclosporin Determination in Whole Blood

We have compared the whole blood concentrations of parent cyclosporin A (CsA) using monoclonal fluorescence polarization immunoassay (FPIA) and radioimmunoassay (RIA) as well as polyclonal FPIA in kidney, heart, and bone marrow transplant patients (n = 89). A good correlation was found between monoclonal FPIA and monoclonal RIA (r = 0.96) and a slightly worse one between polyclonal and monoclonal FPIA (r = 0.90). The interassay coefficient of variation was satisfactory for all the methods-less than 5% for monoclonal FPIA. The monoclonal FPIA assay with Abbott TDx appears to provide rapid, precise, and accurate measurement of parent CsA. It is therefore useful for therapeutic monitoring of CsA in whole blood in kidney, heart, and bone marrow transplant patients.

A prospective study of cyclosporine concentration in relation to its therapeutic effect and toxicity after renal transplantation.

1. Cyclosporine (CsA) concentrations in plasma and whole blood were monitored prospectively in 66 consecutive kidney transplant recipients for 6 months after transplantation or until graft loss. Immunosuppression was based on treatment with CsA and prednisolone in 27 patients and CsA, azathioprine and prednisolone in 39 patients. 2. Whole blood and plasma samples (separated at 37 degrees C) were collected 10-12 h after CsA dosage twice weekly over the first 3 months and thereafter once weekly. CsA concentrations were measured by high pressure liquid chromatography (h.p.l.c.) in plasma, by specific and non-specific monoclonal radioimmunoassays (r.i.a.) in whole blood, and by polyclonal r.i.a. and polyclonal fluorescence polarization immunoassay (f.p.i.a.) in whole blood and plasma. 3. There were no differences between the treatment schedules regarding graft or patient survival, occurrence of acute rejection, nephrotoxicity or infection. 4. CsA concentrations were significantly lower at the time of acute rejection than one week earlier based on all of the analytical methods used except f.p.i.a. 5. The lowest CsA concentration, recorded during the first month after transplantation, was significantly lower in patients with than in patients without experience of acute rejection episodes when the CsA concentrations were measured by polyclonal r.i.a. in whole blood and plasma and by specific and non-specific monoclonal r.i.a. in whole blood, but not by h.p.l.c. in plasma or polyclonal f.p.i.a. in whole blood or plasma. 6. The highest CsA concentration recorded during the second post-transplantation month, was higher in patients with acute nephrotoxicity than in those without nephrotoxicity when CsA was measured by specific monoclonal r.i.a. in whole blood (471 +/- 409 ng ml-1 vs 327 +/- 150 ng ml-1, P less than 0.05), but not by the other methods. 7. The mean plasma h.p.l.c. concentration of CsA measured by h.p.l.c. during the first month after transplantation was significantly higher in patients who suffered from systemic infection than in patients who did not (116 +/- 70 ng ml-1 vs 82 +/- 52 ng ml-1; P less than 0.05). 8. Thus, significant relationships between CsA concentrations and clinical events were apparent using assay methods specific for CsA as well as using polyclonal r.i.a., but not using polyclonal f.p.i.a. When h.p.l.c. was used, however, plasma drug concentrations were often below the limit of determination. Our results suggest that specific analysis of CsA in whole blood allows the best distinction between patients who respond favourably and less favourably to treatment with CsA.

Area-Under-the-Curve Monitoring of Cyclosporine Therapy

The measurement of areas under the concentration-time curve (AUC) was recently introduced as an alternative to trough level monitoring of cyclosporine therapy. The AUC is divided by the oral dosing interval to calculate an average concentration. All measurements are performed at clinical steady state. The initial evaluation of AUC monitoring showed advantages over trough level monitoring with concentrations of cyclosporine measured in serum by the polyclonal radioimmunoassay of Sandoz. This assay technique is no longer available and the following assays were performed in parallel during up to 173 AUC determinations in 51 consecutive renal transplant patients: polyclonal fluorescence polarization immunoassay of Abbott in serum, specific and nonspecific monoclonal radioimmunoassays using 3H and 125I tracers in serum and whole blood, and high performance liquid chromatography in whole blood. Both trough levels and average concentrations at steady state measured by those different techniques were significantly correlated with the oral dose. The best correlation (r2 = 0.54) was shown by average concentrations measured in whole blood by the specific monoclonal radioimmunoassay of Sandoz (3H tracer). This monitoring technique was also associated with the smallest absolute error between repeated observations in the same patient while the oral dose rate remained the same or was changed. Both allegedly specific monoclonal radioimmunoassays (with 3H and 125I tracer) measured significantly higher concentrations than the liquid chromatography. (ABSTRACT TRUNCATED AT 250 WORDS)